There are various settings where Dr Broadhurst may reconstruct the larynx. This is usually in the setting of trauma. Such traumatic injuries can include crush fractures and displacement of the larynx cartilages. It can also involve substantial tissue loss from resection of cancer, which then require reconstruction to improve the voice quality.
Such reconstruction techniques need to be tailor made to the individual patient. As such, a detailed close proximity video endoscopy is performed before surgery. This allows Dr Broadhurst to plan the appropriate reconstructive surgery and explain the techniques and expected outcomes to the patient.
Another area of larynx reconstruction involves transgender patients and the alteration of laryngeal structures to resemble the appropriate male or female makeup. The most common of these performed is the feminisation laryngoplasty (FemLar) devised by Dr James Thomas in Oregon, USA. Dr Broadhurst feels this is the most effective way at creating a more feminine voice for male to female transgender patients. In this setting an incision is made on the outside of the larynx in the overlying skin. The thyroid cartilage is split down the middle and the larynx is then opened. The vocal fold attachments at the front of the larynx are then grasped and sutures placed approximately 4-5 mm toward the back of the vocal fold on each side. The new suture placements are used then to recreate the new front of the vocal folds after the excess vocal fold tissue is then removed. A strip of thyroid cartilage is also removed at the front of each side of the larynx, which overall creates a shortening and a feminisation alteration to the larynx. As such, the vocal folds become shorter and thinner and create a more feminine quality to the voice with the inability for pitch to drop. The goal of this surgery is to place the pitch of the voice around 200 Hz.
Other reconstructive options in transgender surgery include increasing the tension in the vocal folds by cricothyroid approximation sutures. These pull on certain parts of the framework of the larynx, increasing the tension and therefore increasing the pitch of the vocal folds. The other procedure that can be used is a laser laryngoplasty, which thins the superior aspect of each vocal fold. Such thinning causes the vocal folds to tighten and can elevate the pitch.
